RESEARCH - Tight control in the treatment of RA: efficacy and feasibility

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ls of the Rheumatic Diseases 2007;66(Supplement 3 ):iii56-iii60;

doi:10.1136/ard.2007.078360

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INSIGHTS FROM INVESTIGATOR-DRIVEN TRIALS AND GENETICS

Tight control in the treatment of rheumatoid arthritis: efficacy and feasibility

M F Bakker , J W G s , S M M Verstappen , J W J Bijlsma

Department of Rheumatology and Clinical Immunology, University Medical

Center Utrecht, Utrecht, The Netherlands

Objective: To evaluate the available evidence on the efficacy and

feasibility of the new concept of tight control in randomised trials

in patients with rheumatoid arthritis (RA). Tight control is a

treatment strategy tailored to the individual patient with RA, which

aims to achieve a predefined level of low disease activity or

remission within a certain period of time.

Methods: The literature database PubMed was searched and yielded four

trials: the FIN-RACo trial, the TICORA study, the BeSt study and the

CAMERA study.

Results: Tight control resulted in greater improvement and a higher

percentage of patients meeting the preset aim of low disease activity

or remission when compared to the control intervention. In the

FIN-RACo trial, aimed at DAS28<2.6, 51% of patients in the tight

control group achieved remission versus 16% in the contrast group

(p<0.001). In the TICORA study, 65% of patients in the tight control

group versus 16% of the contrast group achieved remission, based on

DAS<1.6 (p<0.0001). In the CAMERA study, 50% of patients in the tight

control group using a computer decision model achieved remission,

versus 37% in the contrast group (p = 0.029). The BeSt study consisted

of only tight control groups aimed at a DAS<1.6; remission was

achieved in 38–46% of patients. This is higher than the range of

remission in earlier trials of 13–36%.

Conclusion: Tight control aiming for low disease activity or even

better still, remission, seems a promising option in treating patients

with RA in clinical trials and probably also in daily practice.

http://ard.bmj.com/cgi/content/abstract/66/suppl_3/iii56

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